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Home My WebLink About1316 SHOREBIRD LN; ; CB004533; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Electrical Permit Permit No:CB004533 Job Address: Permit Type: Parcel No: Reference #: Project Title: Applicant: GREEN LAND CO Building Inspection Request Line (760) 602-2725 1316 SHOREBIRD LN CBAD ELEC 2157910900 Lot#: HAYASHI RES/ELECTRIC-GAS LINE 0 Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: HAYASHI ROBERT ISSUED 12/01/2000 CB 12/01/2000 12/01/2000 1270 PLUM TREE RD CARLSBAD, CA 92009 760-4329999 1316 SHOREBIRD LN CARLSBAD CA 92009 5647 12/01/00 0002 )1. Total Fees: $47.00 Electric Issue Fee Single Phase per AMP Three Phase per AMP Three Phase 480 Per AMP Remodel/Alteration per AMP Remodel Fee Temporary Service Fee Test Meter Fee Other Electrical Fees TOTAL PERMIT FEES Total Payments To Date: 0 0 0 0 $0.00 Balance Due: Clearance: $10.00 $0.00 $0.00 $0.00 $0.00 $10.00 $0.00 $0.00 $27.00 $47.00 CGF· $47.00 NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fe s, dedk:ations, reservations, or other exactions hereafter collectively referred to as "fees/exactions." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capactiy changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project NOR DOES IT APPLY to any fees/exactions of which ou have reviousl been iven a NOTICE similar to this, or as to which the statute of limitations has reviousl otherwise ex ired. PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 1.. PROJECT INFORMATION FOR OFFICE USE ONLY PLAN CHECK NO. C,~)15'3, 5 EST. VAL. __________ _ Plan Ck. Deposit ________ _ Validated Bv,------1.C.-Pz...e;.. __ ~--- Date I?-// J 60 I r I 1.::z / 6 <.5JftJ&e .~ Ld Address (inciude Bldg/Suite #) Business Name (at this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # Proposed Use Clt:S It--- Description of Work #of Stories # of Bedrooms # of Bathrooms 2. CONTACT PERSON (If /llfferent from applicant} c;,.tU,c::.7)) L--lt;III/J e, l:Gl2o Name / Address City 0 Owner O A.gent for Owner State/Zip Telephone # Fax # ·3. APPLICANT 112'.1, Contractor O Agent for Contractor Name Address City State/Zip Telephone# 4. PROPERTY OWNER ~ o Ac/L--r Nahle ff"r> ,'11f3717. Address 731,/, 3/f P/LF J!>,vt.J) L// City (ii:/l.L;SA,,w State/Zip u '? i 1) t/3?'" 3 I-::>/ Telephone# 6. CONTRACTOR • COMPANY NAMJ; (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code] or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 ~any applicant for a permit subjects the ~licant to a civil penalty of not more than five hun,sre_d dollafl;~~ ~/\) L../r-/11.J} ~ • I~ 70 P'-t:k1 7/l..e?'. /2./) C,+,z.L,St$/W CA-T• 'IP 7 Name Address 2 City State/Zip ./.~:'p~_i:ie # State License # 0/ (f; t!,q License Class C 2 City Business License # / "J()~d}',{,! Designer Name Address City State/Zip Telephone State License # __________ _ 6. WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: J!f. I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. D I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: p /, /2 Insurance Company (= A-1'?-P1 ~ Policy No. °J(j •--6 S" 3 2-Expiration Date ijjl ~ / (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100] OR LESS) 0 CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensa e 11 unlawful, and shall subject an employer to crlmlnal penalties and ci fines up to one hundred thousand dollars ($100,000), in ddl n to the co sation, damages as provided for In Section 3706 of the Labor c e, int A~nd attorney's fees. SIGNATUR,"E==:-----l.c-::F-:~~~-......-l~-~~~-=~===-:::------:==::-DATE --''--"'=.,,L...£_....,,L-=.0_0_ 'J. OWNER-BUILPER DECLARATIQ_N I hereby affirm that I am exempt from the Contractor's License Law for the following reason: D I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). D I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). D I am exempt under Section ______ Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES ONO 2. I (have / have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone number/ contractors license number): _________________________________________________ _ 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type of work): ________________________________________________________ _ PROPERTY OWNER SIGNATURE ______________________ _ DATE __________ _ COMPLETE THIS SECTION FOR NON_../IES/DENT1AL BUl!,DING PERMITS ONLY Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act7 0 YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES O NO Is the facility t o be constructed within 1,000 feet of the outer boundary of a school site? 0 YES O NO IF ANY OF THE ANSWERS ARE YES. A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. B .. , CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code). LENDER'S NAME ______________ _ LENDER'S ADDRESS ________________________ _ 9. APPLICANT CERTIFICATION I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the Citt of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 180 a from th date of such permit or if the building or work authonzed by such permit 1s suspended or abandoned at any time after the work is comme ed f a period o 1 0 S ction 106.4.4 Uniform Building Code) 4 ! APPLICANT'S SIGNATURE -1.--4~1!...:!~--~-=~,;;;;:,......---------DATE / 2 _ __/~ WHITE: File YELLOW: Applicant PINK: Finance • UNSCHEDULED BUILDING INSPECTION DATE t>e<et$1C> INSPECTOR -;~~a.l=...._ro...,.___ __ _ PERMIT # Q!>Y5::V-,, PLAN CHECK#----'--'--- JOB ADDRESS \3-\Cr ~e--«½,;.-.t '-f"\ . DESCRIPTION ..J,C.~00-A....,0"6 __ ; .... __________________ _ CODE DESCRIPTION ACT COMMENTS 2,1 Ct,oo 0,; i .- . ·------------~ .. , Inspection List Permit#: CB004533 Type: ELEC Date lnsJ)11ction Item 12/4/2000 21 Underground/Under Floor 12/4/2000 21 Underground/Under Floor 12/4/2000 31 Underground/Conduit-Wirin 12/4/2000 31 Underground/Conduit-Wirin Wednesday, December 06, 2000 HAYASHI RES/ELECTRIC-GAS LINE lnsp11~tor Act Comments RI TL co GASLINE RI TL co Page 1 of 1